PANCE Blueprint EENT (7%)

56 y/o with intermittent loss of vision in the right eye

Patient will present as → a 57-year-old male with a history of hypertension who complains of an acute onset of intermittent headaches and blurred vision of the right eye.

Papilledema is swelling of the optic disk secondary to increased intracranial pressure → classically bilateral but (as in the video example) may be unilateral

• Optic disk swelling resulting from causes that do not involve increased intracranial pressure (eg, malignant hypertension, thrombosis of the central retinal vein) is not considered papilledema.
• There are no early symptoms, although vision may be disturbed for a few seconds. Papilledema requires an immediate search for the cause

Diagnosis is by ophthalmoscopy with further tests, usually brain imaging and sometimes subsequent lumbar puncture, to determine the cause

• MRI or CT scan of the head looking for a cause. Focus on finding intracranial pathology = tumor or bleed, cerebral edema, CSF outflow obstruction or overproduction
• Increased opening pressure with lumbar puncture confirms increased intracranial pressure

Causes include the following:

• Brain tumor or abscess
• Cerebral trauma or hemorrhage
• Meningitis
• Arachnoidal adhesions
• Cavernous or dural sinus thrombosis
• Encephalitis
• Idiopathic intracranial hypertension (pseudotumor cerebri), a condition with elevated CSF pressure and no mass lesion

Urgent treatment of the underlying disorder is indicated to decrease intracranial pressure.

• If intracranial pressure is not reduced, secondary optic nerve atrophy and vision loss eventually occur, along with other serious neurologic sequelae.